Provider Demographics
NPI:1114230398
Name:MILLER, ELAINE ELIZABETH (FNP-RN)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP-RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12677 HESPERIA RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7735
Mailing Address - Country:US
Mailing Address - Phone:760-952-0040
Mailing Address - Fax:760-952-9163
Practice Address - Street 1:12677 HESPERIA RD
Practice Address - Street 2:SUITE 170
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7735
Practice Address - Country:US
Practice Address - Phone:760-952-0040
Practice Address - Fax:760-952-9163
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP19583363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner